| BackgroundHepatocellular carcinoma(HCC)is the most common primary liver cancer,and 70%of patients are ineligible for radical surgical resection at the time of onset.Recently,hepatic arterial infusion chemotherapy(HAIC)plus Lenvatinib treatment has been increasingly used to treat patients with unresectable HCC.Although the therapeutic effect is considerable,there are still some non-responders to the combination therapy,and the tumor cannot be controlled effectively.Therefore,early identification of poor response to treatment is helpful for physicians to change the plans in time and also improve the prognosis of patients.Previous studies demonstrated that the hepatic arteries in patients with HCC shrink significantly after administration of molecular targeting drugs,such as sorafenib and Lenvatinib.Besides,it can be seen in clinical practice that patients with reduction of hepatic artery diameters after treatment are more likely to achieve better tumor response and prognosis.Therefore,this study observed and analyzed the changes of hepatic artery diameters after HAIC plus Lenvatinib treatment,and explore the relation with the clinical efficacy.MethodsSixty-seven participants with unresectable HCC receiving HAIC combined with Lenvatinib for the first-line treatment were enrolled in this retrospective study.The patients received HAIC every 3 weeks,followed by oral Lenvatinib 3 days after the first HAIC course.Digital Imaging and Communication of Medicine data of Epigastric enhanced Computer Tomography before treatment and after one and two months of treatment were collected and introduced into the image post-processing workstation for hepatic artery reconstruction and diameter measurement.Meanwhile,the changes of tumor capillaries were also observed in pathological specimens before and after treatment.The antitumor response after 1,3,and 6 months of treatment was assessed using the modified Response Evaluation Criteria in Solid Tumors(mRECIST)and calculate the objective response rate(ORR).And the progression-free survival(PFS)and over survival(OS)rate were confirmed by clinical follow-up.Then the relationship between the diameter of hepatic artery branches and tumor reaction as well as PFS were analyzed.ResultsThe average age of enrolled patients was 50.5±12.0 years,including 59 males and 8 females.64 patients were followed up successfully,and the lost follow-up rate was 4.5%.The average and median PFS were 8.1±4.2 months and 8 months respectively;the 6-and 12-month OS rate were 90.6%(58/64)and 64.1%(41/64)respectively.According to mRECIST,46,41,and 24 patients had complete or partial responses after 1,3,and 6 months of treatment,respectively,whereas 21,21,and 32 patients had stable or progressive disease at these times,and the ORR were 68.7%,66.1%and 42.9%respectively.The hepatic artery diameters were all significantly decreased after 1 and 2 months of treatment(P<0.001),but there was no difference in the vessel diameter between 1 and 2 months(P>0.05).The microvessel density in tumor lesions decreased significantly after the combination treatment(P<0.001).Shrinkage of the tumor-feeding artery was closely related to the tumor response after 1,3,and 6 months of treatment(P<0.001,P=0.004,and P=0.023,respectively)and an independent factor for treatment efficacy(P=0.001,P=0.001,and P=0.002,respectively);however,the changes of other hepatic arteries were not significantly related to tumor response.Furthermore,the PFS was significantly prolonged in patients with thinning of tumor-feeding artery in early stage(P=0.004).ConclusionThe hepatic artery diameters were reduced rapidly in the early stage after HAIC plus lenvatinib treatment,and the thinning of the tumor-feeding artery was closely related to better clinical efficiency.Therefore,the change of tumor-feeding artery diameter can be used to evaluate the tumor response and prognosis of patient with unresectable HCC. |
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